Tonsillotome



W. H. IRVINE TONS ILLOTOME July 13, 193 7.

Filed Oct. 50, 1954 dlw .N

wm m V I Wham WHHA Patented .Fully 13, 1937 5:11, TPS

'EUNSELLOTMIE Application October 3l), i934, Serial No. 750,619

'i' Claims.

This invention relates to tonsillotomes and while the instrument isprimarily adapted for the removal of tonsils it is also adapted for usein other surgical operations.

It is an object of the invention to provide an improved tonsillotomeembodying an craseur with means to position the same relative to thetonsilar space in the passage from the mouth tol the pharynx with meansto actuate the craseur to effect enucleation or extirpation oi thetonsil by compressing the tonsil at the base or neck to preventhemorrhage and the abscission of the tonsil pedicle.

ln instruments of this character heretofore l5 there has been provided acarrier bar arranged as a handgrip at one end and the opposite eX-tremity arranged with a member o distal fenestra form as a means toapproach the tonsilar space, the craseur comprising a strand o' suitablematerial, preferably wire, attached at the opposite ends to a slidemount-ed upon the carrier bar intermediate the handgrip and distalmember, the wire being arranged intermediate the ends to loop form andthe loop expanded and 25 positioned relative to a recess interior of thefenestra wall of the distal member and positioned about the tonsil bythe distal member and said loop in the removal of the tonsil beinggradually diminished or contracted to compress the tonsil by moving theslide upon the carrier bar. In such instruments the distal member is offlat form with the result that when it is positioned relative to thetonsilar space only an intermediate portion of the tonsil will beembraced by the craseur loop and it is impossible to extirpate thetonsil and only a part of the tonsil may be removed, as by cutting. Itis a further object oi the invention to overcome this disadvantage byarranging the distal member of ovate or spoon shape, that is, ci convexform in longitudinal and transverse section, and offset the distalmember relative to its carrier at the juncture o the distal member withthe carrier, whereby the tonsilar space may be more closely approachedby the distal member and position the loop of the craseur to engage andcompress the tonsil at the base or neck and assure the enucleation orextirpation of the tonsil, and the provision of means to guide thecraseur during the actuation thereof.

A further object of the invention is to provide in tonsillotomes meansto co-operate with the craseur to effect an abscission of the pedicle ofthe tonsil enucleated or extirpated by the ecra- Seur.

(Cl. 12S-309) 1t is another object of the invention to provide thetonsillotcmes with a fenestra distal member and arrange a portion of theenestra wall with a cutting edge disposed in opposed relation to theoutermost curved portion of the enestra Wall and the craseur loop whenpositioned in the recess in the outer portion oi the fenestra Wall ofthe distal member tol co-operate with they craseur loop during thediminishing of said loop to cleave the pedicle of the enucleated tonsilthereby and eiiect abscission of the tonsil.

Other objects and advantages will hereinafter appear.

In the drawing accompanying and forming a part of this application,Figure 1 is a plan View of my improved tonsillotome showing the craseurwire in partially diminished or contracted position.

Figure 2 is a side elevation, partly in section, to show the connection.of a thumb or nger engaging member with a carrier bar for the operativeparts of the tonsillotome, and showing means to releasably lock thecraseur actuating slide in adjusted position on the carrier bar andshowing the same in slid-e releasing position.

Figure 3 is a longitudinal sectional view of the distal member to` showthe connection thereof with the carrier member, the arrangement of thecraseur wire relative thereto, and the cutting means to e'i'ectabscission of the pedicle of an enucleated tonsil, the section beingtaken substantially on the line 3 3 of Figure 1 looking in the directionof the arrows.

Figure 4 is a sectional view, on an enlarged scale, taken on the linel-l of Figure 1 looking in the direction of the arrows to show thearrangement of the craseur actuating slide and the means to releasablylock said slide to the carrier bar.

Figure 5 is a cross sectional View taken on the line 2i- 5 of Figure llooking in the direction of the arrows to show the mounting of the meansto releasably lock the craseur actuating slide on the carrier bar.

Figure 6 is a cross sectional View taken on the line (-t of Figure 1looking in the direction of the arrows to show the arrangement of theconnection of the distal and bar members and the arrangement oi thecutting means to cooperate with the craseur wire to effect abscission ofthe pedicle of the tonsil; and

Figure 7 is a View taken substantially on the line l-l of Figure 1looking in the direction of the arrows to show the arrangement of guidesat opposite sides of the carrier bar for the engagement and guiding ofthe craseur wire.

In carrying out the embodiment of the invention illustrated in thedrawing there is provided a carrier for the operative parts of thedevice in the form of a bar 8 arranged at one end portion as a handle,the bar preferably being of rectangular shape in cross section having areduced screw threaded shank 9 extended from one end for the threadedconnection of an annular thumb or nger engaging member Ill. The oppositeend portion is arranged of increased width, as at II, and the extremityarranged as a member of distal fenestra form in that the end wall is ofarcuate form and has a circular therethrough with the outer end wallopening of annular form and extending through an arc slightly greaterthan 180 degrees, as shown at I2 in Figure l, and provided in theinterior surface thereof with a groove or recess I3, as shown in Figure3. 'I'he distal member is of ovate or spoon shape in that it is ofconvex form in longitudinal and transverse section and is 01T- setlaterally of the carrier bar 8 substantially midway the ends of theportion of increased width II, as at M. The wall of the opening in thedistal member opposite the annular wall portion I2 is arranged as acutter I5, the cutting edge I 5 of which extends substantially in an arcof 180 degrees and merging at the opposite ends with the annular wallportion I2. This cutter is formed by undercutting or recessing the uppersurface of the handle at the juncture of the distal member rearwardlyfrom the cutting edge I5 to a point substantially at the oiset of thedistal member, as at I6, thereby arranging the cutter of a thicknesssubstantially the same as the outer convex wall of the recess I3 andsaid cutting edge merging in said recess wall. The opposite side wall ofthe recess I3 is'of the same width for an arc of substantially 180degrees when it is reduced in width to less than the width of theextremities of the arcuate cutting edge, as at I2', and then merges withportions of arcuate form, as at II, of the side wall of the undercutportion I6, the wall of said arcuate portions being recessed or undercutto constitute in effect continuations of the recess I3 and spaced aparta distance less than the diameter of the opening in the distal member toextend substantially in line with guideways in the form of bores I8through the portions of increased width at opposite sides of the carrierbar 8, the end wall of said undercut portion I6 also being recessed andthe end wall of the recess arranged of arcuate form, as shown at I9 inFigures 1 and 6. The cutter I5 is of concave form in cross section, asshown in Figures 3 and 6, and diminishes to flat form rearwardly fromthe cutting edge to where it merges with the carrier bar 8. It will beobvious that by this arrangement of the distal member that the tonsilarspace in the passage of the mouth to the pharynx may be closelyapproached by the convex surface thereof with the wall of the opening inthe distal member embracing the base or neck of the tonsil.

To enucleate or extirpate the tonsil and simultaneously therewithcompress the tonsil at the base or neck to prevent hemorrhage an craseurof suitable material is provided, preferably consisting of a wire loop20 formed by bending a strand of wire upon itself intermediate the endswith the opposite ends extended through the guide bores I8 whereby theloop may be positioned relative to the recess I3 in the wall I2 of theopening in the distal member and the recesses in the parts I'I, as shownin Figure 1. The craseur loop is normally positioned and concealedwithin the recess I3 of the distal member, as shown in Figure 3, and toeffect a gradual diminishing or contraction and movement of the loopacross the opening in the distal member, the opposite ends of the wireare releasably connected to an actuator mounted on the carrier bar 8. Inthe embodiment shown this actuator comprises a slide 2i of rectangularshape in cross section having an opening therethrough conforming to andfor slidable engagement on the carrier bar 8, the slide being providedwith oppositely extending annular finger grips 22. The actuator slidewith the finger grips may be a casting, or the same may be formed ofsheet metal and the nger grips secured thereto, as by welding. Toreleasably secure the ends of the wire to the actuator slide they areextended through openings in the juncture of the nger grips 22 withthe'slide, as at 23, and releasably clamped to the ringer grips bycoiling the extremities of the wire about and below the heads of screwsthreaded into the finger grips, as shown at 24 in Figures 1 and 2.

To releasably lock the slide against movement on the carrier bar withthe craseur loop engaging the recess I3 in the distal member or ineither of its diminished or actuated positions, the actuator slide forthe craseur is provided with a loci:- ing detent to engage in either oneof a series of transverse notches 25 spaced longitudinally of thecarrier bar. This locking detent is shown in the form of a plate 26 ofresilient material secured in juxtaposed relation to the slide 2I bylips 2? extended upward from the slide and engaging over the oppositemarginal side portions of the plate adjacent one end, as shown inFigure 1. The one end of the plate extends beyond the end or the slideopposite the craseur wire and is provided with a laterally extendingpawl 28 to engage a notch 25 under the inherent tension of the plate.

To release the detent from a notch 25 and retain it in released positionto permit of free sliding movement of the craseur actuator slide on thecarrier bar to adjust the craseur loop to position within the recess I3of the distal member and to diminish or contract said loop, means areprovided to move the pawl end of the detent plate against its inherenttension and thereby disengage the detent pawl from a notch 25 and holdsaid end of the detent in such position. For this purpose the oppositeplate intermediate the attaching ears 21 and pawl end of the detentplate are arranged with eyes 29 to be disposed in parallel relation tothe periorations in ears 3i] extended upward from the slide 2I for thepivotal engagement of the ends of a pintle SI arranged with cams 32disposed within the eyes 29 of the plate, the pintle being provided withan operating lever or nger grip 33. position of the actuating lever toextend in contiguous relation to the detent plate 26 with the cams outof engagement with the eyes 29 of the detent, as shown in Figure 4, theparts being retained in said position by the inherent tension of thedetent plate. To move the detent pawl 28 out of engagement with a barnotch the lever is actuated to the position shown in Figure 2, therebyrotating the pintle 3I and therewith the cams 32 which move the plateagainst its inherent tension to p0- sition the detent pawl out ofengagement with a marginal portions of the bar notch, as shown in Figure2, the plate co-operating with the cams toretain it in said position.

In operation the craseur actuating slide 2l is released from the carrierbar to permit movement of the actuator slide upon said bar. The craseurloop is then adjusted to position it within the recess l3 of the distalmember, when the detent plate 26 is released to permit it under itsinherent tension to engage the pawl 28 with a bar notch 25. With theparts in said positions the tonsilar space is approached by the convexsurface of the distal member to engage the tonsil in the openingtherein. With the instrument so positioned the craseur actuator slide isactuated to diminish or contract the craseur loo-p which may be effectedby engaging the iingers within the ringer grips 22 of the actuator andsupport the instrument with the other hand grasping the nger grip Il),or the finger grip l may be engaged by the thumb of the hand the fingersof which engage the linger grips 22 of the actuator. The detent pawl 28may be so arranged that b-y exerting a predetermined force on theactuator through the finger grips 22 to cause the pawl to yieldinglyride over the bar notches, or the detent may be released by the lever 33before operating the craseur actuator, which may be readily effected byengaging the finger or thumb nail below the end of the lever 33 andexerting an outward force thereon.

By the arranging of the distal member of ovate or spoon form andoffsetting the distal member relative to its carrier bar, the craseurloop may be positioned closely to the base or neck of the tonsil, andasthe loop is partly contracted and moved out of the -groove I3 it has atendency to move laterally and downwardly from the distal member due tothe inherent tension of the wire and be forced into the tonsilar space.This diminishing of the loop is gradual and effects a compressing of thetonsil and the simultaneous enucleation or extirpation of the tonsil.Simultaneously with the diminishing of the ecraseur loop, it is movedrelative to the cutting edge i5 and effects an abscission of the tonsilpedicle. This is efficiently accomplished by the arrangement of guidingthe ecraseur wire through the guideways I8 and causing a movement of thecompressed tonsil relative to and in the direction of the cutting edgel5', and said cutting edge due to the concave form and the form of thecutting edge, which is in the nature of a shear edge beveled inward fromthe concave side to the convex side, and the guiding of the craseur wirerelative to the walls Il, causes the craseur wire to be moved incontiguous relation to the convex face of the cutter and cutting edgeand thus assuring a positive abscission of the tonsil and its pedicle bythe cutter. The craseur actuator is operated until the craseur loop ismoved relative to the cutter I5, which is in the nature of a shelf, andthe loop is positioned relative to the arcuate wall of the recess i9,when there will be a complete abscission of the tonsil and the tonsilpedicle. Should the tonsil pedicle be tough with the result that theremay not have been a complete abscission of the tonsil pedicle by thecutter I5 by adjustment of the craseur loop to position relative to thearcuate wall of the recess I9 will cause such portion of the enucleatedtonsil pedicle to lie relative to the shelf or cutter and in whichposition it may be readily snipped ci by a pair of scissors.

It will be obvious that the parts may be readily disassembled forcleaning or substitution of parts and as readily reassembled byreleasing the ends of the craseur wire 2B from the attaching screws 261when the wire may be readily withdrawn from the guideway it, and by theunscrewing of the l'inger grip it from the carrier bar the craseuractuator slide 2l may be read- -ily removed from the carrier bar.

To effect a cauterizing of the tonsil pedicle the craseur wire may beconnected in circuit with a source of electricity to effect a heating ofthe loop, in which case the carrier bar with the distal member, as wellas the craseur actuator slide, will be made of an insulating material,such as bakelite.

While I have illustrated and described one embodiment of my invention,it will be obvious that modiications may be made in the construction andarrangement of parts Without departing from the scope of the invention,and that parts of the invention may be used without others and comewithin the scope of the invention.

Having thus described my invention, I claim:

l. In a tonsiliotorne, a handle having an end portion of increased widthterminating at the end in a fenestra of ovate form having a circularopening therein and adapted to approach the tonsilar space with thefenestra wall embracing the tonsil, said fenestra opening having arecess in and extending about the outer portion of the wall of theopening and communicating at the juncture of the ovate fenestra portionwith the handle with a guideway at each opposite side of and extendingparallelly oi the handle, a wire looped upon itself and the oppositeends extended relative to said guideways in the handle and the loopedportion adapted to be positioned in the recess in the wall of theenestra opening, and means to which the ends of the wire are attachedslidably mounted on the handle and operative to move the loop relativeto the fenestra opening.

2. In a tonsillotome, a wire looped upon itself intermediate its ends, amember including a handle having an end portion of increased widtharranged at the end of ovate shape having a circular opening thereinwith a recess and guide in the outer portion of the wall of said openingfor the engagement of the wire loop, a guideway at each side of theportion of increased width of the handle within the ovate shaped end andat each side of the handle merging with said recess for the engagementand guiding of the wire, and means slidable on the handle to which theends of the wire are attached operative to partly diminish the size ofand move the wire loop relative to the opening in the ovate shaped end.

3. A tonsillotome as claimed in claim 2, wherein the means to partlydiminish and move the wire loop relative to the opening in the ovateshaped end comprises a slide mounted on the handle to which the ends ofthe wire are attached, a spring detent mounted on said meniber normallyurged to engage one of a series of notches in the handle to releasablylock the slide against movement on the handle, and means to move andhold said detent out of notch engaging position.

4. In a tonsillotome, a wire looped upon itself intermediate its ends, ahandle having at 0D@ end a distal member of ovate shape having acircular opening therein arranged with a recess in the outer portion ofthe Wall of said opening for engagement of the Wire loop and the innerportion of the Wall of the opening arranged with a cutting edge opposedto and extending in the plane of the recess in the outer portion of theWall of the opening, and said member having guideways at each side ofand within the ovate distal member merging with the recess in the Wallof the opening in the distal member for the engagement of the oppositeend portions of the Wire and guiding of the Wire loop, and means towhich the opposite ends of the Wire are attached slidable on the handleand operative to partly diminish and draw the Wire loop in the ovatedistal member and relative to the cutting edge to compress and extirpatethe tonsil and eiect abscission of the tonsil pedicle.

5. In a tonsillotome, a Wire looped upon itself intermediate its ends, ahandle having a portion of increased Width at one end terminating at theend in a distal member of ovate shape having a circular opening thereinwith a recess in the outer portion of the Wall of the opening for theengagement of the Wire loop and the wall of the opening opposed to therecessed Wall portion arranged with a cutting edge, a guide- Wayarranged at each opposite side of the portion of the handle of increasedWidth Within the ovate distal member merging with the recess in theouter Wall of the opening for the engagement and guiding of the Wire atopposite sides of the loop, and means to which the ends of the Wire areattached mounted on the handle and operative to partly diminish and drawthe Wire loop transversely of the opening and relative to the cuttingedge to compress and extirpate the tonsil and effect abscission of thetonsil pedicle.

6. A tonsillotome as claimed in claim 5, Wherein the face of the handleat the juncture of the ovate distal member with the handle is recessedto form the cutter and the cutter is of concave form in cross section inopposed relation to the convexity of the ovate distal member with theconcavity of the cutter diminishing to at form rearwardly from thecutting edge, and the side Walls of said recess being arranged withrecesses to guide the Wire loop relative to the cutting edge toco-operate therewith to effect a cleavage of the tonsil.

7. In a tonsillotome, a bar arranged with an arcua e distal portion ofovate form having an opening therein, a cutting edge arranged on theinner portion of the Wall of said opening, a guidev/ay in the outerportion of the Wall of the opening opposite the cutting edge theopposite end portions of which guideway intersect the opposite ends ofthe cutting edge and eX- tend in a direction toward and terminate ateach opposite side of the bar, a member slidably mounted on the bar,means to releasably retain said member against movement on the bar, and

with the opposite end WILLIAM H. IRVINE.

